A comparison of the long‐term consequences of vaginal delivery versus caesarean section on the prevalence, severity and bothersomeness of urinary incontinence subtypes: a national cohort study in primiparous women. Issue 12 (21st June 2013)

• Record Type: Journal Article
• Authors: Gyhagen, M; Bullarbo, M; Nielsen, TF; Milsom, I
• Is Part Of: BJOG. Volume 120:Issue 12(2013:Dec.)
• Page Start: 1548
• Page End: 1555
• Publication Date: 2013-06-21
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12367
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12367-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12367-sec-0001" sec-type="section"> <title>Objective</title> <p>To study the effect of one vaginal delivery (VD) compared with one caesarean section (CS) on the prevalence, severity and bothersomeness of urinary incontinence (UI) subtypes—stress (SUI), urge (UUI) and mixed (MUI)—20 years after delivery.</p> </sec> <sec id="bjo12367-sec-0002" sec-type="section"> <title>Design</title> <p>Registry‐based national cohort study.</p> </sec> <sec id="bjo12367-sec-0003" sec-type="section"> <title>Setting</title> <p>Women who returned postal questionnaires (response rate 65.2%) in 2008.</p> </sec> <sec id="bjo12367-sec-0004" sec-type="section"> <title>Population</title> <p>Primiparae with one birth in 1985–88 (<italic>n</italic> = 5236) and no further births.</p> </sec> <sec id="bjo12367-sec-0005" sec-type="section"> <title>Methods</title> <p>Medical Birth Register data were linked to a questionnaire. Analysis of variance and multivariate analysis were used to obtain adjusted prevalences and odds ratios (adjOR).</p> </sec> <sec id="bjo12367-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Prevalence, risk factors, severity, bothersomeness of UI subtypes.</p> </sec> <sec id="bjo12367-sec-0007" sec-type="section"> <title>Results</title> <p>The prevalence of SUI, UUI and MUI was 15.3, 6.1, 14.4%, respectively, and was higher for all subtypes after VD versus CS. Moderate to severe incontinence was more prevalent after VD (21.3%) compared with CS (13.5%; adjOR 1.68, 95% confidence interval [95% CI] 1.40–2.03). Bothersome incontinence differed between MUI (38.9%), UUI (27.1%) and SUI (18.0%). The prevalence of bothersome UI was higher after VD compared with CS (11.2 versus 6.3%; adjOR 1.85, 95% CI 1.42–2.39) and consulting a doctor for UI was reported more often after VD than CS. Bothersome MUI occurred in 40.0% of incontinent women after VD compared with 29.9% after CS (adjOR 1.65, 95% CI 1.07–2.54). Symptomatic pelvic organ prolapse was an important modifier of UI with regard to its prevalence, duration, type and bothersomeness.</p> </sec> <sec id="bjo12367-sec-0008" sec-type="section"> <title>Conclusion</title> <p>The prevalence of SUI, UUI and MUI was higher and moderate to severe UI and bothersome UI were reported more often after VD than CS 20 years after one delivery.</p> </sec> </abstract>